I work as a staff nurse at the SpecialistPalliative Care Cancer Unit. It provide high quality holistic care centred onthe needs of patients and their families. The aim is to enrich the quality oflife through the skills of an experienced and caring team. Counselling andbereavement support service is available for patients as well as for relativesand friends. Other services include specialist rehabilitation team, studycentre, research centre and telephone advice. Complementary therapies such asmassage, aromatherapy, reflexology and hypnotherapy are provided by trainedpractitioners for patients.
The unit serves to care forpatients with advance cancer, complex symptom management of cancer, chronic endstage diseases where symptomatic management is the only option and chronic endstage diseases. End of life Care also plays a big role in the care services thatis provide at my work place. Patients and families use the varied facilitiesavailable here and staff help them guide and support them throughout theirhospital stay until discharge to appropriate setting and/or death.The team compromises ofconsultants, registrar, consultant anaesthetist and junior doctors; The nursingstaff, Occupational therapist, Physiotherapist, Complementary therapist,Community/Hospital Macmillan Nurses, Pharmacist, Porter, Volunteers, VoluntaryServices Manager, Receptionists, Domestic staff, Day Care staff, Counsellors,Administration Manager, Medical Secretary and Admin Support Co-ordinators. Eachone of them play an important role in the functioning of the unit with thepatient being the main focus. Students have a great opportunity to meetdifferent team members and see how they fit into the big picture and gaininformation about the care of end of life patients.Patients are either referred fromthe community through community Macmillan team or GP’s or through the hospitalMacmillan team.
Most of the patients are known to the unit as they come to theday unit on a regular basis for activities and to see their consultant forfollow up clinics. Providing End of life care topatients who are dying or are in their last days of their life is the mostimportant and different thing that I am part of. We are very different fromother areas in terms of its ambiance that we provide to patients and families.
Preparing patient and family and having open conversation about death anddying, providing emotional support to support them. The amount of observationand its frequency are less compared to the other wards. We use the highestnumber of controlled drugs in the trust due to the complexity of painmanagement for cancer patient that we care for. Palliative sedation is anotherarea that we specialise in and make sure that terminal agitation (agitationthat happens before patients are dying) are identified and patient is keptcomfortable and settled around this hard time in their life.
The unit welcomes nursingstudents from all years and assist them with placement facilitation. There areenough mentors and associate mentors to support students throughout their timeat the unit. The allocation of students to their mentor is done by the linknurse for mentorship at the work place. The mentor is also informed about thearrival of the students. Students are welcomed to come before hand to have atour of the placement area. Initial interview is very important and key inidentifying the expectations and needs of the student nurse. Work rota is alsodiscussed and agreed with the mentor in this interview so that they can worknearly 40% of their placement time with the mentor as expected by Nursing andMidwifery Council (NMC).
Patients die in the unit and weprovide last offices with dignity and respect. Support family and provideinformation to them on what happens next after the death of their loved ones,regarding registration of death and papers works that follow it. We arecompassionate and have unique communication skills that the students can learnwhile they are at the placement.Students are vulnerable when theycome to practice (Huybrecht et al 2011) and they need to be supported andsocialised into the practice area (HCPC 2014, NMC 2015).
The unit makes surethat students are well supported in their placement. There is a named mentorand associate mentor and various others experienced staffs who support thestudents and make them feel welcomed to the new placement and make them feel confidentand be a part of the team. We get students from year1 to year 3 and alsomanagement students and students on insight visit to the ward.Once the students arrives fortheir first day at placement they are made welcomed by all staff members onduty and are shown around the unit. Induction to the ward assist students toknow what learning facilities are available within the area and they areencouraged to ask question and know more about the unit and its functioning.The students work with the mentor and learn new skills and develop on it.Students knowledge, skills and attitude towards practises and patients andnoted and advice is given if needed to support them.
Students are encouraged tovisit other areas within the unit on insight visit and on teaching days so theycan see how the whole unit function in a holistic manner.Evidenced based practise is animportant aspect that we bank upon in all that we do at work place. There isteaching session, training and insets days for staffs to update on new thingsand what the best practise guidelines are. We all adhere to the trust policyand our benchmark score on documentation and other aspect are very good and isa good reflection of safe and sound practise area. There is also a researchteam that are closely linked to our unit and studies are carried out based onthe subject criteria. Staffs helps the research nurses and also they update uson new things in changes to practise.
Work place is a challenging areaas it is different from other areas in terms of the deaths that we frequentlyhave here, it is emotionally draining and needs a lots of support from othermembers of staff to support each other and we have a good support system atwork. Most to all patients who are admitted to the ward have Do Not AttemptCardio Pulmonary Resuscitation (DNACPR) and all deaths are expected. Nurseshere have a unique role of verification of death of these patients after theydie, so as in others ward, we don’t need to wait for the doctor to do theverification of death. These with many other skills students have a full rangeof skills to learn at the placement setting.